Senior Clinical Investigator - 533077
Position Description
Job Description:
- Claims Processes: Pre-authorization, Cashless Processing, Adjudication, Verification, audit & providing medical opinion
- Evaluation of Treatment & associated costs
- Evaluation of Health Claims Ratio
- Acts as a Clinical Consultant.
- Participate in evaluating new facilities for application of hospital computer systems and programs.
- Prepare reports and analyses setting forth progress, adverse trends and appropriate recommendations and/or conclusions on subjects relating to system management in clinical care. Communicates and represents opinions, policies, concerns and needs of the assigned areas.
- Ensures coordination of support services to deliver customer centric services.
- Assists in establishing and developing policies and procedures for the assigned areas of responsibility and ensuring alignment and compliance
- Exhibits ability to react to and manage change
- Performs any other duties assigned by competent authorities as required
- Evaluation of Treatment & associated costs
- Evaluation of Health Claims Ratio
- Acts as a Clinical Consultant.
- Participate in evaluating new facilities for application of hospital computer systems and programs.
- Prepare reports and analyses setting forth progress, adverse trends and appropriate recommendations and/or conclusions on subjects relating to system management in clinical care. Communicates and represents opinions, policies, concerns and needs of the assigned areas.
- Ensures coordination of support services to deliver customer centric services.
- Assists in establishing and developing policies and procedures for the assigned areas of responsibility and ensuring alignment and compliance
- Exhibits ability to react to and manage change
- Performs any other duties assigned by competent authorities as required
Requirements
Desired Profile:
- Medical Graduate with minimum 2+ years of experience in Indian Health Insurance- TPA, In- House Claims processing unit
- Good applied medical knowledge
- Having experience working in ICU/ICCU, Secondary/Tertiary care hospitals
- Knowledge of Fraud triggers, past experience in mitigating fraud & managing a Fraud Investigation team
- Must be a licensed physician with recent medical practice required and at least 12 months of experience as a practicing clinician
- Excellent interpersonal, negotiation, and man-management skills
- Superior goal accomplishment skills
- Understanding of data processing methods and procedures, and computer software systems in healthcare settings.
- Knowledge and understanding of best-practice policy and procedure with regard to information systems use in healthcare.
- Excellent interpersonal skills and ability to communicate effectively
- Knowledge of Medical Coding-ICD & CPT codes
- Knowledge of ICD 9 cross-walks
Education: MBBS, BHMS, BAMS, BUMS, BPT - Good applied medical knowledge
- Having experience working in ICU/ICCU, Secondary/Tertiary care hospitals
- Knowledge of Fraud triggers, past experience in mitigating fraud & managing a Fraud Investigation team
- Must be a licensed physician with recent medical practice required and at least 12 months of experience as a practicing clinician
- Excellent interpersonal, negotiation, and man-management skills
- Superior goal accomplishment skills
- Understanding of data processing methods and procedures, and computer software systems in healthcare settings.
- Knowledge and understanding of best-practice policy and procedure with regard to information systems use in healthcare.
- Excellent interpersonal skills and ability to communicate effectively
- Knowledge of Medical Coding-ICD & CPT codes
- Knowledge of ICD 9 cross-walks
Experience: 2-3 years
Apply Here.. http://careers.unitedhealthgroup.com/careers/data/jobs/Claims/533077%20Senior%20Clinical%20Investigator.aspx?utm_source=indeed.com&utm_medium=job_posting&utm_campaign=branding&utm_term=&utm_content=
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